The long thoracic nerve continues along the lateral chest wall to supply the lower slips of serratus anterior at the shoulder level, with branches entering each serratus digitation. The shoulder-level serratus branches supply the critical lower serratus slips responsible for scapular upward rotation.
The shoulder-level branches of the long thoracic nerve supply the most clinically critical serratus anterior slips for overhead shoulder function. Isolated lower serratus weakness from mid-long thoracic nerve injury produces medial scapular winging with overhead arm elevation rather than the global winging seen with proximal injury. These shoulder-level branches are at risk in axillary surgery and lateral thoracotomy.
Selective winging of the inferior scapular angle during arm elevation from injury to shoulder-level long thoracic nerve branches, producing limitation of arm elevation rather than the full medial winging of proximal injury.
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